Climate change and climate variability will rank among the most important environmental and public health challenges of the 21st century. Yet, there remains significant gap in information and understanding regarding how specific populations will respond to climatic stressors. The overarching goal of this study is to establish the linkages and dynamics between heat waves and chronic diseases outcomes, among the Chickasaw people in south central Oklahoma. Specific aims are to (i) reconstruct heat wave patterns affecting the Chickasaw Nation jurisdictional area from 1949 to the present and investigate temporal trends in the frequency and severity of heat waves; (ii) analyze the spatial and temporal distribution of cause-specific acute morbidity and mortality within Chickasaw communities during periods of heat wave activity; and (iii) to characterize and map the risk for heat-related morbidity and mortality according to chronic disease prevalence, population attributes, and community environmental characteristics. The findings of this study will advance our understanding of how future climate might impact chronic diseases especially among vulnerable groups, as well as inform adaptation planning and public health efforts beyond the study area. The project takes advantage of access to unique climate and health databases and a strong desire on the part of the study population to research their own health disparity. The study will reconstruct the climatology of heat waves using statistical methods, develop community exposure profiles, and link these with demographic, medical, and social-cultural information using GIS and geospatial analytical methods. The distribution of disease specific outcomes will be statistically and empirically compared with the community heat exposures to learn how disease may be related to both social characteristics and incidences of heat waves. The major expected outcomes include (a) improved understanding of how heat waves impact the distribution and progression of chronic diseases, (b) the characteristics of at- risk sub populations, and (c) predictive model of how future climate change could impact vulnerable populations. The methodology, insights, and results of this study will constitute a useful reference source for other studies on climate and health in other parts of the world with similar comparable characteristics.